Integrated suite of medical tools

ABSTRACT

The present disclosure is directed to a tool that can be used to order, dispense, locate, request and administer medications as well as locate, issue and administer medical items and supplies for patients from a plurality of entry points into the system, e.g. handheld devices, mobile cart, etc. New workflows and functionality for various devices such as dispensing devices (automated dispensing cabinets) and issuing devices (e.g. open shelving) are also disclosed. Because of the rules governing abstracts, this abstract should not be used to construe the claims.

The present invention claims priority from U.S. application Ser. No.60/525,396 filed Nov. 26, 2003 and entitled Integrated Suite of MedicalTools, the entirety of which is hereby incorporated by reference.

BACKGROUND OF THE INVENTION

The present disclosure is related to computer operated devices forcontrolling the ordering, dispensing, issuing and administration ofmedical items including drugs and supplies for patients.

There currently exists a number of devices that may be used in ahealthcare setting for controlling the ordering, dispensing, andadministration of medical items, including drugs and supplies, under thecontrol of a computer. Performing such functions under the control of acomputer allows data to be gathered that can be used for billing,reordering of stock as well as creating an audit trail. Such devicesinclude, for example, imaging devices for inputting new prescriptions ornew orders for patients into a central pharmacy system, computercontrolled dispensing cabinets, hand held scanners that can be used forbedside administration of drugs, and open bins of supplies having alocal computer into which information relating to the issuing ofsupplies for patients can be logged. Such devices can be purchased froma variety of vendors.

Some devices, such as the handheld bedside scanners, require asubstantial investment in infrastructure which may create a barrier inthe sales process. In U.S. patent application Ser. No. 09/998,121 filedNov. 30, 2001 and entitled Method Of Issuing Medical Supplies AndDispensing and Administering Medications Through A Hand-Held Device AndSystem For Doing The Same, which is hereby incorporated by reference,the assignee of the present invention has proposed integrating intotheir handheld bedside scanner the ability to issue medical suppliesfrom open bin storage shelving. However, the investment in suchinfrastructure is not currently being fully leveraged to provideadvantages for other devices used by nurses such as the imaging devicesand computer controlled cabinets.

From the user's point of view, integrating into one device the abilityto dispense medications, issue supplies, and administer dispensedmedications seems convenient, but the underlying infrastructure andrules applicable to each of these processes makes integration difficult.For example, medications are typically dispensed by a pharmacy. Thepharmacy may be set up using a centralized dispensing model,decentralized dispensing model, or a combination of the two. In each ofthe three models, various combinations of automated (e.g. unit baseddispensing cabinets), partially automated (e.g. carousels), or manual(e.g. open shelving) equipment may be used. As medications aredispensed, counts must be maintained to insure that the pharmacy doesnot run out of the needed medications. Counts may be maintainedautomatically in computer controlled devices, manually, or a combinationof both. Provision must also be made to accommodate returned medicationsthat have been dispensed for a patient but have not been administered,e.g. the patient has been discharged, prescription has been changed,etc.

The pharmacy must also be capable of interaction with other systems. Forexample, the pharmacy is responsible for communicating with insurancecompanies or clearing houses to determine if a patient's insuranceallows for substitution and, if so, what are the allowable substitutes,as well as to determine what the patient's insurance will pay for. Thepharmacy system must interface with the healthcare facility's billingsystem and systems for reordering medications.

As might be expected, the pharmacy is governed by various rules. Forexample, in all cases, except certain emergency situations, medicationsdispensed for a patient must be reviewed by a pharmacist. Rules may bein place that require each prescribed medication to be cross-checked forinteractions with other medications ordered for the patient and to bechecked against known patient allergies. The pharmacy may also beresponsible for tracking the age and lot numbers of medications toinsure that expired medications and recalled medications are quicklyremoved from the distribution chain. When one considers that a pharmacymust perform all these functions and follow all these rules for perhapsthousands or even tens of thousand of prescriptions a day, it is easy tounderstand that the operation of a pharmacy has become a complicated andspecialized process.

In addition to dispensing drugs for administering to a patient, a nurseor other healthcare worker may also need to have supplies issued for apatient. Supplies are typically controlled by a materials managementdepartment within a healthcare facility. Supplies typically are notregulated as are medications and therefore materials managementdepartments often do not need to follow the same strict rules that areapplicable to pharmacies. Nevertheless, the materials managementdepartment must be able to keep track of current inventories to insurethat all needed supplies are on hand. That can be a daunting task forseveral reasons. First, there may be thousands of items in inventory.For each item, that item may be available from various suppliers atdifferent prices with each supplier using its own unique stock number.Also, supplies are often kept in open bins or shelving. When items areremoved, it is up to the user to remember to document the items'removal. Often times, such documentation is not performed, and items canbe low or out of stock without the materials management departmentlearning of such situations until a manual count is performed. Thematerials management department must interact with the healthcarefacility's billing system and supplier's systems for reorderingsupplies.

The nursing function is one way that the healthcare facility interactswith patients. Nurses dispense medications for patients, either from acentralized or decentralized pharmacy. Nurses also issue supplies forpatients. It can be time consuming to dispense all the necessarymedications and issue all the necessary supplies for each patient on thecurrent round for that nurse as medications and supplies are not kept inthe same storage locations, and both medications and supplies may not bewhere they are supposed to be located. Also the procedures fordispensing medications are different than the procedures for issuingsupplies. For example, the procedure for dispensing a medication from aunit based cabinet is very different from the procedure for issuing asupply from open bins. Finally, the administering of medications to apatient is strictly governed by rules, whereas the delivery of suppliesto a patient is not. The administration of medications must insure thatthe right patient, receives the right dose of the right drug, via theright route, at the right time. The administration process must also bedocumented to create an audit trial. Thus, in addition to tending to theneeds of patients, a nurse must be aware of a variety of differentdispensing and administering schemes for drugs as well as issuing anddelivery schemes for supplies.

Nursing has identified certain problems in dispensing schemes utilizingcomputer controlled dispensing cabinets. One problem is nurses takingcentral pharmacy dispensed medications from a patient specific cassettefor another patient that is assigned to another nurse. In suchsituations, medications cannot be found where they are expected to be.Another problem is that nurses waste time waiting in lines at computercontrolled dispensing cabinets at peak times. It would save significanttime if nurses could either get all their medications in one place or ifthey knew exactly where to go to get the medications they needed.Existing infrastructure could also be leveraged if additionalfunctionality could be added to devices currently being used for otherfunctions.

BRIEF SUMMARY OF THE INVENTION

The present disclosure is directed to an integrated suite of tools forcontrolling the ordering, dispensing, issuing and administration ofmedical items including drugs and supplies for patients from a pluralityof entry points into the system, e.g. handheld devices, mobile cart,etc. New workflows and functionality for various devices such asdispensing devices (automated dispensing cabinets) and issuing devices(e.g. open shelving) are also disclosed.

One embodiment of the present disclosure is directed to a system havingan automated medication dispensing device. A computer located remotelyof the automated dispensing device communicates with the dispensingdevice, or a database that maintains an inventory of items locatedwithin the dispensing device, and sends a queue of dispensing orders tothe dispensing device. An authentication device confirms when the useris located proximate to the dispensing device. The dispensing device isresponsive to the authentication device for performing the queueddispensing orders.

Another embodiment of the present disclosure is directed to a systemhaving a medication dispensing system and a computer located remotely ofthe dispensing system for communicating with the medication dispensingsystem, or a database that maintains an inventory of items locatedwithin the dispensing system, to identify a location within themedication dispensing system where items to be dispensed are located.

Another embodiment of the present disclosure is directed to a methodcomprising: inputting logon information into a system via a remotecomputer; creating via the remote computer a list of medications todispense; verifying that an authorized user is located proximate to adispensing device; transmitting the list of medications to thedispensing device; and dispensing the medications on the list.

Another embodiment of the present disclosure is directed to a methodcomprising: inputting logon information into a system via a remotecomputer; maintaining in a database an inventory of items located withina dispensing device; communicating with the database via the remotecomputer to build a list of medications to be dispensed; verifying thatan authorized user is located proximate to the dispensing device;transmitting the list of medications to the dispensing device; anddispensing the medications on the list.

Another embodiment of the present disclosure is directed to a methodcomprising: inputting logon information into a system via a remotecomputer; and identifying via the remote computer a location within amedication dispensing system where items to be dispensed are located.

Another embodiment of the present disclosure is directed to a methodcomprising: inputting logon information into a system via a remotecomputer; maintaining in a database an inventory of items located withina dispensing system; and communicating with the database via the remotecomputer to identify a location within the medication dispensing systemwhere a medication to be dispensed is located.

BRIEF DESCRIPTION OF THE DRAWINGS

For the present disclosure to be easily understood and readilypracticed, the present disclosure will now be described, for purposes ofillustration and not limitation, in conjunction with the followingfigures, wherein:

FIG. 1 is a diagram illustrating the use of a handheld device to controlthe operation of a variety of different devices;

FIG. 2 illustrates a flow of data between a handheld device, anapplication server, a central server, a distributed dispensing cabinet,pharmacy automation, and prescription input devices;

FIG. 3 is an overview of an exemplary workflow embodying the principlesof the instant disclosure;

FIGS. 4A and 4B illustrate a workflow for building a list of medicationsto dispense and a document dispense workflow, respectively;

FIGS. 4C, 4D, and 4E are exemplary screen shots of information that canbe illustrated at various points in the workflow of FIGS. 4A and 4B;

FIGS. 5A, 5B and 5C illustrate a workflow for generating and handlingrequests for missing medications;

FIGS. 6A-6F illustrate a workflow for collecting and dispensingmedications;

FIG. 7 illustrates a workflow for issuing supplies;

FIG. 8 illustrates a workflow for administering medications and issuingsupplies;

FIG. 9 illustrates a workflow for handling waste medications; and

FIG. 10 illustrates an alternative workflow to the workflow illustratedin FIG. 6A in the event that a cart is available.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 illustrates a handheld device 10. The handheld device 10 may beembodied in a variety of platforms including personal computers, tabletpersonal computers, PDA's, and the like. One type of handheld device 10is a commercially available device such as the AdminRx handheld deviceavailable from McKesson Automation Inc. Such handheld devices aretypically programmed to operate as wireless medication scanners used atthe point of care to verify and chart medication administrations whileproviding a legible, real time medication administration record as shownby box 12. By scanning the medication, patient identification, and nurseidentification, such handheld devices help to prevent life-threateningand costly medication errors by confirming the right patient, rightmedication, right dose, right time and right route.

Vendors of handheld device 10 now offer CCD barcode scanners thatsupport imaging. That will allow a nurse to use a handheld device toscan an image of a doctor's written prescription, or new order for apatient, and submit it for input to the pharmacy system as illustratedby the box 14. The equipment represented by box 14 could also be, forexample, a MedDirect product available from McKesson Automation Inc.

With appropriate programming of handheld device 10, a nurse could walkinto a supply storage area with handheld device 10 and scan a barcodethat identifies a particular storage location. For example, if openshelving 16 is provided, the nurse could scan a barcode, such as barcode18. The nurse could then use the handheld to begin scanning supplyproducts to be issued for a chosen patient. Multiple nurses could workin an open supply area at the same time. Also, supply areas would notnecessarily need a nurse workstation any longer, such as workstation 20.If workstation 20 is eliminated, the replenishment function may be addedto the handheld device 10. Although the supply storage area illustratedin FIG. 1 shows open shelving 16, other types of storage may be providedsuch as, for example, towers, whether locked or unlocked, carousels, andthe like. If the supply storage area is locked, the user would use thehandheld device 10 to unlock the storage device.

In the upper left hand corner of FIG. 1 a dispensing cabinet 22,auxiliary cabinet 24, and lockable tower 26 are illustrated. Byproviding nurses with functionality on the handheld device 10 to latercontrol dispensing from a dispensing device, it is possible to guidethem to either the patient cassette and/or cabinet/tower/etc. to findtheir medications the first time. As a result, nurses would be lesslikely to borrow medications from another patient's cassette if they aresteered to where they are certain they can find the medication. Nursescould also use the handheld device 10 to request medications be sent upstat from a central pharmacy. Nurses could also significantly reducetheir time in front of a cabinet by logging on to the handheld device10, selecting one or more patients, and selecting the medications to bedispensed for each of the selected patients. Thereafter, when they stepup to the dispensing cabinet 22, they can transfer the information aboutthe selected patient and the medications to be dispensed to the cabinetby any suitable means. For example, the handheld device 10 may be dockedin cradle 28 or the information may be wirelessly transferred to thecabinet 22. Thus, when the nurse has access to the cabinet, the nursecan immediately begin dispensing for patients instead of beginning thepatient dispensing process by selecting patients and medications fromtouch screen 30.

The handheld device 10 could be replaced by a computer on a mobile cart(not shown). Other computers, located remotely of the dispensing devicessuch as shelving 16 and cabinet 24, may be used to provide certain ofthe functionality illustrated in FIG. 1. For example, a computer at anursing station could be used to scan new prescriptions and provide thefunctionality of box 14 as well as construct a queue of dispensingorders to be transmitted to the cabinet 22. Clearly, if the remotecomputer is not mobile, it cannot be taken into a storage room wheresupplies are kept or to the patient's bedside. Thus, it is not necessarythat all of the functions illustrated in FIG. 1 be present in anyparticular device or system.

By providing additional functionality, handheld devices 10 could becomepersonal devices, assigned to and registered to a caregiver at the startof a shift. Alerts, messaging, and voice communications could then beadded to the device.

Various dataflows and workflows will now be described for purposes ofillustrating the disclosure. The concepts disclosed herein are not to belimited to the illustrated dataflows and workflows.

Turning now to FIG. 2, a flow of data for one particular architecture isshown for purposes of illustration and not limitation. Data flowsbetween the handheld device 10 and a central server 34 through anapplication server 36. The handheld device 10 may obtain order statusfrom the central server 34. The handheld device 10 may create overrideorders or send missing medication requests to the central server 34. Acentral database 42 may reside on the central server 34. The centraldatabase 42 may be a Connect-Rx database available from McKessonAutomation Systems, Inc., although other database products may be used.The location of the central database 42 will depend upon thefunctionality to be provided by the various components such that thelocation of the central database 42 is not important in the context ofthe present invention.

In FIG. 2, communication between the handheld device 10 and thedispensing cabinet 22 through the application server 36 is alsoillustrated. Resident on the dispensing cabinet 22 or associatedtherewith, is a local database 44. Data in the form of a list ofmedications to be dispensed is sent to the local database 44 andinformation regarding the availability of the medications is sent fromthe database 44 to the handheld device 10. A login procedure may also beexecuted between the handheld device 10 and the cabinet 22. Thedispensing cabinet 22 is also capable of creating override orders whichare input to the local database 44. The dispensing cabinet 22 is justone component of a dispensing system which may include, for example,auxiliary cabinet 24, tower 26, a virtual cabinet 47, a patient cassette48, open shelving (not shown in FIG. 2), a medication storage room (notshown), among others.

A replication function 46 may provide override orders from the localdatabase 44 to the central database 42, as well as to insure that theinformation on the two databases is consistent.

Missing medication requests may be sent to automation equipment 38 suchas the McKesson Robot-Rx automation device and the McKesson MedCarouselautomation device from the central database 42.

The central database 42 is also in communication with a McKessonMedDirect order entry system 40 or other prescription input device and aprinter (not shown) to create medication orders, missing medicationnotifications and override order notifications. The reader shouldunderstand that the dataflow illustrated in FIG. 2 is exemplary only andthat other dataflows may be implemented depending upon the capabilitiesof the various equipment comprising the system.

FIG. 3 is an overview of an exemplary workflow embodying the principlesof the instant disclosure. In FIG. 3, a login procedure is carried outat 50. The login procedure may be the normal login procedure used on aremote computer such as the Admin-Rx device. Thereafter, at 52, the usermay select a patient through any convenient manner, i.e., pick list,manually entered, scanning a bar code, etc. The user may then view thepatient's ordered medications and may choose those medications to bedispensed so that they may be later administered to the patient.

After the patient is selected at 52, a due list is viewed at 54. The duelist indicates all of the medications which that healthcare worker is toadminister in the next medical administration round (MAR). Thereafter,an inquiry 56 determines whether Connect-Rn is enabled. Connect-Rnrefers to a software module that embodies the principles of the presentinvention. It is anticipated that in facilities currently using theAdmin-Rx device 10 as well as McKesson dispensing cabinets 22, thatConnect-Rn will be a software module that can be purchased to enable thedata flows discussed above in conjunction with FIG. 2. If Connect-Rn isnot enabled, then process flow continues with a process 58. Process 58represents the collect and dispense medication process which isdescribed in greater detail in FIGS. 6A-6F. After the medications havebeen collected and dispensed through process 58, an inquiry 60determines if there are more Admin-Rx tasks for this patient. If theanswer is yes, then other features available on the Admin-Rx device areused at 62. For example, a process 64 may be carried out in whichsupplies may be issued in accordance with the work flow illustrated inFIG. 7. After the other features have been used, or if there are no moreAdmin-Rx tasks for this patient, an inquiry 66 is made as to whetherthere are more patients to view. If that determination is affirmative,process flow returns to 52. If there are no more patients to view, thenthe healthcare worker may proceed to administer the medications andsupplies according to the workflow illustrated in FIG. 8, represented bybox 68 in FIG. 3. Thereafter, the healthcare worker may logout at 70.

Returning to the inquiry 56, if Connect-Rn is enabled, then the user isgiven the option 72 of creating a dispense list. If a dispense list isto be created, the dispense list may be built according to the workflowillustrated in FIGS. 4A and 4B, represented by the box 74 in FIG. 3.Thereafter, or if the dispense list is not to be built, process flowcontinues with the inquiry 76. Inquiry 76 determines if any of themedications is missing. If medications are missing, a procedure forgenerating and processing a missing medication request may be performedas shown in FIGS. 5A-5C, represented by box 78 in FIG. 3. Thereafter, orif no medications are missing, process flow continues with process 58.

Process 58, as mentioned above, is implemented by the workflowillustrated in FIG. 6A-6F in which medications are collected anddispensed. An inquiry 80 is made to determine if it was possible tocollect all of the medications. If all the medications were successfullycollected, process flow continues with the inquiry 60. However, if allof the medications were not successfully collected, an inquiry 82 ismade as to whether Connect-Rn is enabled. If yes, a request for missingmedications can be performed as represented by the process 78. If not,medications need to be requested in another manner, such as calling thepharmacy. Thereafter, process flow continues with the inquiry 60.

FIGS. 4A and 4B illustrate a workflow for building a list of medicationsto dispense and a document dispense workflow, respectively. In FIG. 4A,the process begins at 90 in which medications and their locations aredisplayed. An exemplary screen shot is illustrated in FIG. 4C whichillustrates one technique for displaying a medication together with itslocation. After the medications and their locations are displayed, aninquiry 92 determines if any medications have been previously dispensedbut not yet administered. If answered in the affirmative, at 94 the drugand the person who dispensed the drug are illustrated. Thereafter, or ifno medications were previously dispensed but not administered, processflow continues at 96. At 96, medications residing in a dispensingcabinet such as the AccuDose dispensing cabinet 22 may be selected. Asseen from FIG. 4C, various medications are shown as being available incabinet station: 1. Those medications may be selected to build adispense list.

Thereafter, an inquiry 98, is made as to whether the selectedmedications should be saved as a dispense list. If the inquiry isanswered in the affirmative, then the dispense list is saved at 100 tothe central database (42 in FIG. 2) or, if answered in the negative, thedispense list is discarded at 102. From both 100 and 102, process flowcontinues at inquiry 104 which is an inquiry regarding whether to selectnon-due medications. If that determination is answered in theaffirmative, a display of non-due medications is provided at 106. Anexemplary display is illustrated in FIG. 4D. From 106, process flowcontinues with an inquiry 108 which determines whether to add theselections to the dispense list. If that inquiry is answered in theaffirmative, the selections are added at 110 to the dispense list on thecentral database or, if answered in the negative, the selections listedare discarded at 112. From either 110 or 112, the dispense list createdmay be displayed at 114. An exemplary dispense list is illustrated isFIG. 4E. As seen from FIG. 4E, a variety of medications are available inpatient specific cassettes, certain medications are available at adispensing cabinet, while the location of other medications is unknown.After the list has been displayed, or from the “no” branch of inquiry104, an inquiry 116 is made as to whether more medications are to beselected. If yes, process flow returns to 96. If no, process flowcontinues with the document dispense work flow illustrated in detail inFIG. 4B, represented by box 118 in FIG. 4A. Thereafter, the processterminates at 120.

Continuing with FIG. 4B, the process begins with an inquiry 124 in whicha determination is made if Connect-Rn is enabled. If Connect-Rn is notenabled, then preparation of the dispense documents cannot be performedat this time and the process ends at 140. If Connect-Rn is enabled,process flow continues with inquiry 126 in which a determination is madeas to whether the ordering physician is known. If the ordering physicianis not known, the ordering physician is determined and entered at 128.Thereafter, or if the ordering physician was known, an inquiry 130 ismade as to whether this is an override order. If it is determined thatthis is not an override order, then process flow terminates at 140. Ifthis is an override order, then an inquiry 132 is made as to whether anoverride witness is required. If yes, the witness is recorded at 134.After the witness is recorded, or if no witness is necessary, an inquiry136 is made as to whether an override reason is required. If an overridereason is required, the override reason is entered at 138. Thereafter,or if no reason is required, process flow ends at 140. The readerdesiring more information about override situations is directed to U.S.Pat. No. 6,650,964 entitled Medication Dispensing Apparatus OverrideCheck And Communication System and U.S. Pat. No. 6,671,579 entitledOverride Having Built In Audit Trail For Medication Dispensing AndAdministering Systems, both of which are hereby incorporated byreference in their entireties.

Returning briefly to FIG. 3, process 74 builds the dispense list asdescribed in conjunction with the workflows of FIGS. 4A and 4B. Afterthe dispense list is built, the inquiry 76 determines whether any of themedications are missing. If medications are missing, the request for amissing medication can be made and that request filled as will now bedescribed in conjunction with FIGS. 5A-5C. In FIG. 5A, an inquiry 144 ismade whether the ordered medication for a patient is found in the unit.If it is, process flow continues with inquiry 146 which determineswhether additional medications are to be found. If not, the process endsat 148. If more medications are to be found, process flow continues byreturning to inquiry 144.

At inquiry 144, if it is determined that the ordered medications are notfound in the unit, another inquiry 150 determines whether Connect-Rn isenabled. If Connect-Rn is enabled, then the drug and quantity may beselected at 152. An exemplary screen shot 153, connected to 152 via abroken line, illustrates the information which may be displayed and fromwhich a selection can be made. After a selection is made, the selecteddrug and quantity is stored as a missing medication request in centraldatabase (42 in FIG. 2) at 154. Thereafter, the missing medicationrequest is processed as will be described in conjunction with theprocess 156 illustrated in detail in FIG. 5B. The status of theprocessing of the missing medication request may be displayed at 158.The display may include an estimated time of arrival. From either 158,or 150 if that inquiry results in a negative determination, process flowcontinues with inquiry 146.

Turning to FIG. 5B, the missing medication request is stored in thecentral database at 160. Inquiry 162 determines, based on userpreferences, available hardware, among others, whether the requestshould be sent to a printer, some type of pharmacy software, ordelivered directly to automation equipment for filling the missingmedication request. The phrase Automation equipment refers to automated(e.g. Robot-Rx robot) or semi-automated (e.g. MedCarousel, NarcStation)hardware used for filling a prescription. In the case of delivery of themissing medication request to a printer, a missing medication request isprinted at 164. Printing typically indicates that the request is to befilled in a manner that does not rely upon automation equipment forfiling the prescription. In the case of delivering the missingmedication request to some type of pharmacy system, that may beaccomplished by sending the missing medication request to a MedDirectdevice. A missing medication icon and information are generated andplaced into a missing medication folder at 166. An alert condition iscreated at 168. From either 164 or 168, an inquiry 170 is made if therequest may be forwarded to automation equipment or if a manual pick ofthe medication is required. If the request may be forwarded ontoautomation equipment, or directly from inquiry 162, the request isforwarded to automation equipment which executes a workflow as shown,for example, in FIG. 5C, represented by box 172 in FIG. 5B. After themedication has been dispensed at 172, the medication is then deliveredto the floor at step 174, using any appropriate delivery system, e.g.runner, tube system, cart/cassette from a robot, etc. The incident isarchived at 176 and the process ends at 178.

Returning to inquiry 170, if it is determined that the request may notbe forwarded to automation equipment, a manual pick is performed at 180.After the manual pick is performed at 180, an inquiry 182 is made todetermine if the request came from a pharmacy system. If the answer isyes, then the status of the missing medication is updated at 184 in thepharmacy system. For example, the pharmacy system may be notified thatthe prescription has been filled so its status can be changed todelivered. Thereafter, or if the request did not come from a pharmacysystem, process flow continues at 174 with the medication beingdelivered to the floor in any suitable manner.

In FIG. 5C, dispensing of the missing medication through the use ofautomation equipment is illustrated. A series of inquiries 185-188determines the equipment in which the missing medication may be found.More specifically, inquiries are made as to whether the medication is ina robot 185, in a carousel 186, in a NarcStation 187 or in a med shelfor other device 188. If any of those inquiries is answered in theaffirmative, then a dispense is performed from the appropriate device.For example, if the medication is determined at 185 to be in the robot,a dispense from the robot is performed at 190. If the medication isdetermined to be in a carousel at 186, a dispense from the carousel isperformed at 191. If a determination is made at 187 that the medicationis in a NarcStation, a dispense from the NarcStation occurs at 192. Ifit is determined at 188 that the medication is in a shelf or otherlocation, a dispense from the shelf or other pharmacy automation occursat 193. After the dispense 190-193, the status of the missing medrequest is updated at 194. The update 194 may be similar to or the sameas the update 184 in FIG. 5B. The process ends at 198. If it isdetermined after all of the inquiries 185-188 that the medication is notin automation equipment, then the medication is manually picked at 196and the process ends at 198.

Additionally, instead of being determined serially as shown in FIG. 5C,followed by a filling process, a determination may first be made as towhich automation equipment contains the medication, and then logic maybe used to determine which automation equipment is best suited to fillthe request, e.g. fill the prescription with the device having theoldest stock, the device having the least amount of stock, etc.

Although not shown in FIGS. 5A-5C, it is possible the missing medicationrequest may be denied for a variety of reasons, e.g. out of stock,medication not approved for patient, etc. Under such circumstances, amessage may be sent to the user indicating that the request has beendenied or cannot be fulfilled.

Not shown in FIGS. 5A-5C are additional inquiries that may beincorporated into the workflow. For example, an inquiry can be made todetermine if the requested missing medication is in the next cart fill.If yes, an inquiry can be made to determine if the cart fill deliverywill be timely. If delivery is timely, the missing medication requestneed not be filled again. If the medication is not in a cart beingdelivered, or if it is in a cart being delivered, but delivery will notbe timely, an inquiry can be made to determine if a cabinet refill ispending. If yes, and the refill is timely, it is not necessary to fillthe missing medication request.

In FIG. 6A, an exemplary workflow 232 for collecting and dispensing ofmedications is illustrated. The workflow 232 of FIG. 6A begins atinquiry 200 in which a determination is made as to whether Connect-Rn isenabled. If it is enabled, another determination is made at inquiry 202as to whether the medications are identified as being in a cassette. Ifthat inquiry is answered in the affirmative, or if it is determined atinquiry 200 that Connect-Rn is not enabled, the user needs to walk tothe cassette as illustrated by 204. At 206 the user determines whichmedications to dispense from the cassette. At 208 medications which areto be dispensed, and which are actually present in the cassette, aredispensed. It should be noted that some medications may be identified at202 as being in the cassette, but not actually in the cassette due tovarious problems.

After the medications are dispensed at 208, inquiry 210 determines ifConnect-Rn is enabled. If Connect-Rn is enabled, then the list ofmedications is updated at 212 to remove any medications on the list(indicating that they are present in the cassette), but not actuallypresent in the cassette, and to decrement the count for medications thathave been removed. Thereafter, process flow continues with inquiry 214.If, at 210, Connect-Rn is not disabled, process flow continues withinquiry 214.

At inquiry 214, a determination is made whether the medications are in adispensing cabinet, such as the AccuDose-Rx cabinet. If not, thecollection of medication ends at 216. If, however, the inquiry at 214 isin the affirmative, then a procedure 218 for collecting medications fromthe cabinet is performed, as shown in greater detail in FIG. 6B.Thereafter, the process ends at 216.

FIG. 6B illustrates an exemplary workflow 218 for collecting medicationsfrom an automated cabinet such as the AccuDose-Rx cabinet. The processbegins with a login procedure 220 to the cabinet. The login procedure220 is shown in greater detail in FIG. 6C. After the login procedure220, a patient is selected by a process 222 discussed in greater detailhereinbelow in conjunction with FIG. 6D. After a patient has beenselected by process 222, a determination is made at inquiry 224 if thereare items in that patient's dispense list. If that determination isanswered in the affirmative, then the selected patient's dispensed listis displayed at 226. Thereafter, at 228, medications are selected to bedispensed. The dispense list for an AccuDose-Rx cabinet is made up ofall medications selected for the current patient regardless of how themedications were selected, e.g. from a Connect-Rn dispense list, anAccuDose-Rx profile, an AccuDose-Rx override list, an AccuDose-Rxinventory list, among others.

The dispensing cabinet may then perform pre-dispense tasks asrepresented by the box 232 and as described in greater detail inconjunction with FIG. 6E hereinbelow. The medications are dispensedaccording to a process 234 discussed in greater detail in conjunctionwith FIG. 6F. After dispensing of the medications, an inquiry 236determines if there are more medications on the dispense list. If yes,process flow returns to 230. If not, an inquiry 238 determines if thereare more patients for which medications are to be dispensed. If yes,process flow returns to process 222. If not, the process ends at 240.

Returning to the inquiry 224 as to whether there were any items in thepatient's dispense list, if that determination is negative, a subsequentinquiry 242 determines the dispense mode. There are numerous possibledispense modes. In the exemplary workflow illustrated in 6B, twodispense modes, dispense by profile and dispensed by inventory, arepossible. If there is to be a dispense by profile, then the patient'sprofile is displayed at 244. If there is to be a dispense by inventory,then the inventory list is displayed at 246. From either 244 or 246,process flow continues with 228 in which medications are selected todispense.

Turning to FIG. 6C, an exemplary login process 220 is illustrated. Aninquiry 250 determines whether Connect-Rn is enabled. If yes, the useruses an authentication device to confirm that the user is locatedproximate to the cabinet. The authentication device may take the form ofa bar code which is scanned at 252. Other types of authenticatingdevices may be used such as an RF ID tag embedded in the badge of theuser, a fingerprint scanning device, or other biometric device, amongothers.

After the user confirms that the user is located proximate to thedispensing device, the dispense lists are located on the central serverat 254. All lists created by the user for this cabinet will betransferred at 256. The user's ID and PIN number are transferred at 258.The transfer is preferably a wireless RF transmission, but could be byother means, e.g. physical docking of the hand held device 10 with adocking station (not shown).

At inquiry 260 a determination is made as to whether an autologin isenabled. If yes, the user is automatically logged in using the user IDand PIN number transferred to the cabinet. It will be seen from theforegoing that if Connect-Rn is found to be enabled at inquiry 250, andthe autologin found to be enabled at inquiry 260, the user's logon tothe cabinet is seamless and transparent to the user. The user simplyscans the bar code at 252, or operates some other type of authenticationdevice for confirming that the user is at the cabinet, and the user isautomatically logged in. Thereafter, the login process ends at 264.

If, at inquiry 260, the autologin is not enabled, the user must entertheir PIN at 266 and press a login button, or take some otherconfirmatory action, at 268. The process ends at 264.

Returning to the inquiry 250, if Connect-Rn is not enabled, the usermust manually login by entering the user's ID at 270, entering theuser's PIN at 272, and pressing a login button at 274, or taking someother confirmatory action. The login process ends at 264.

FIG. 6D illustrates an exemplary workflow 222 for selecting a patient.At inquiry 280, a determination is made as to whether Connect-Rn isenabled. If Connect-Rn is not enabled, a list of patients is displayedat 282. For example, all patients in the user's, unit's zone may bedisplayed. At 284 a patient is selected from the list, e.g. the zonelist, among others. The process ends at 286.

Returning to the inquiry 280, if Connect-Rn is enabled, a determinationis made regarding the number of patients for which dispense lists havebeen created. If the number is zero, the process continues at 282 bydisplaying a list of all the available patients. If only one patient hasa list, that patient is automatically selected at 290 and the processterminates at 286. If there is more than one patient with a list, thelist of patients with dispense lists is displayed at 292. At 294 theuser selects a patient from the dispense list and the process ends at286.

In FIG. 6E, an exemplary workflow 232 for the document dispense processis illustrated. Beginning at inquiry 300 a determination is made if adispense witness is required. If a dispense witness is required, thedispense witness information is entered at 302. Thereafter, or if nodispense witness is required, a determination is made at 304 ifConnect-Rn is enabled. If yes, then the document dispense workflow hasalready been completed as discussed in conjunction with FIG. 4B and theprocess ends at 306. If Connect-Rn is not enabled, then the variousinquiries, i.e. is the ordering physician needed 126, is this anoverride order 130, etc. are made as discussed above in conjunction withFIG. 4B. When completed, the process ends at 306.

The process 234 for dispensing medications is illustrated in FIG. 6F.The process for dispensing medications 234 begins with an inquiryregarding whether Connect-Rn is enabled. If not, the dispense quantityis automatically populated with zero at 422, and if enabled, thedispense quantity is automatically populated based upon theadministration dose at 424. From either 422 or 424, the user specifiesor adjusts the quantity to dispense at 426. The cabinet drawer andpocket are opened at 428. At 430 the medications are removed from thepocket and a count is made of the medications remaining in the pocket at432. The count may be used to update inventory records. The pocket anddrawer are then closed at 434.

An inquiry 436 determines whether Connect-Rn is enabled. If not, a wastemedication process 438 can be performed as discussed in detail inconjunction with FIG. 9. If Connect-Rn is not enabled, or after thewaste medication process 438 is performed, the process ends at 440.

Returning briefly to FIG. 3, it is seen that process 64 is a process forissuing supplies, which is described in detail in conjunction with FIG.7. It should be noted, however, that the workflow for issuing supplies64 need not be performed in the sequence illustrated in FIG. 3. Forexample, the issue supplies procedure 64 could be performed before thecollection of medications procedure 58 or may be performed after themedications have been administered according to the process 68.Furthermore, the issue supplies procedure 64 could be performed in amanner such that supplies are issued prior to the dispensing ofmedications. Thus, the issue supplies procedure 64 may be viewed as astand alone procedure, the performance of which is unrelated to thecreation of the list of medications to be dispensed, location of themedications to be dispensed, collection of the medications to beadministered as well as the administration of the medications.

FIG. 7A illustrates an exemplary workflow 64 for issuing supplies. Theworkflow begins when the user goes to a supply location as representedby 320. Thereafter, supplies are collected at 322. At inquiry 324 adetermination is made if Connect-Rn is enabled. If yes, at inquiry 326 adetermination is made if the user is at the default supply location. Ifthe user is at the default supply location, then the supplies arescanned at 328 and the process ends at 330. Alternatively, if the useris not at the default supply location, then the supply location isentered at 332 and process flow continues with the scanning of thesupplies at 328. The supply location may be entered in a variety of wayssuch as scanning a bar code, automatically reading an RF ID tag, amongothers.

If, at inquiry 324, it is determined that Connect-Rn is not enabled, theuser will be required to login to a supply issuing system, such as theSupply Scan system available from McKesson. After logging on through thesupply issuing system's computer (See 20, FIG. 1), a patient is selectedat 336 and the supply scanned at 328. The process can be repeated foradditional patients.

Another process for issuing supplies is illustrated in FIG. 7B. Theprocess illustrated in FIG. 7B assumes that Connect-Rn is available.After the user has gone to a supply location, the process begins atinquiry 340 where a determination is made as to the issuing mode. Theissuing mode may be select by bed 342, patient 344, or by mappingcharges to a unit 346. If the select bed 342 mode is chosen, charges aremapped at 348 to the current patient in the selected bed. From either348, 344 or 346 process flow continues with an inquiry 350 to determineif the supply is in a closed area. If yes, inquiry 352 determines if thedoors are open. If they are not, the location bar code is scanned at 354and all location doors are open at 356. After the doors are open at 356,or it is determined at 352 that the doors are already open, or if thesupply is not in a closed area, process flow continues at 358. At 358the supply is scanned. At 360, the supply count is decremented by oneand the user picks up the supply at 362. Inquiry 364 determines if moreof the same supply is needed. If yes, process flow returns to 358. Ifnot, process flow continues with inquiry 366 which determines ifsupplies are needed which are not in this location. If the answer isyes, an inquiry 368 determines if anyone else is logged in and, if not,all doors are closed at 372. After the doors are closed at 372, or if itis determined that others are logged in at 368, other locations the useris authorized to access are displayed at 374. An inquiry 378 determinesif the supply is in one of these other locations. If yes, process flowcontinues with the inquiry 350. If no, process flow continues with 380in which a supply request is sent to materials management. Feedback isdisplayed to the user at 382 and process flow continues with enquiry 384which determines if the user is done issuing supplies. If yes, theprocedure ends at 386 and, if not, the procedure continues by returningto inquiry 340.

Returning to the inquiry 366, if it is determined that the user does notneed supplies in another location, process flow may continue with theinquiry 384. If desired, the determination as to whether anyone else islogged in and, if not, closing all the doors may be performed betweenthe inquiry 366 and the inquiry 384.

Returning briefly to FIG. 3, the process 68 for administration ofmedications and supplies is shown in greater detail in FIG. 8. FIG. 8begins with the user going to the patient at 390. The administration isvalidated at 392 using procedures appropriate to that healthcareinstitution. Thereafter, the administration is charted at 394.

At inquiry 396, a determination is made as to whether Connect-Rn isenabled. If not, process flow ends at 398. If Connect-Rn is enabled,process flow continues with the waste medication procedure 438 shown indetail in FIG. 9. Process flow ends at 398.

The workflow for the waste medication procedure 438 illustrated in FIG.9 begins with an inquiry 402 to determine if a medication is to bewasted. A waste situation can arise due to a number of differentfactors. For example, a patient may be prescribed a 250 milligram dose,but the medication is provided in a 500 milligram tablet. Under suchcircumstances, the tablet is broken in half, with one half beingadministered to the patient and the other half wasted. Should such asituation occur, the medication is wasted at step 404 according towhatever procedures may be applicable for that medication. At 406 thewaste amount is entered.

At inquiry 408, a determination is made as to whether a reason for thewaste is required. If yes, the reason for the waste is entered at 410.Thereafter, or if no waste reason is required, process flow continueswith inquiry 412 in which a determination is made as to whether thewaste method must be documented. If yes, the waste method is documentedat 414. Thereafter, or if no waste method documentation is required, theprocess ends at 416.

Returning to FIG. 3, process 58 is for collecting and dispensingmedications as discussed more fully in conjunction with FIG. 6A. In FIG.6A, it is assumed that the nurse or healthcare worker is gatheringmedications and placing the medications in their pocket or perhaps intosome type of container. The present invention contemplates the use of amobile cart. In the event that a mobile cart is available to the nurseor healthcare worker the workflow of FIG. 10 may be implemented in placeof the workflow of FIG. 6A.

In FIG. 10, the workflow begins at 450 by moving the cart to the patientspecific cassettes. An inquiry 452 determines whether any of thecassettes are for patients for which the nurse is to administermedications. If that inquiry is answered in the affirmative, the nursescans the cassette bar code 454 and scans all medications in the patientspecific cassette at 456. By scanning all the medications in the patientspecific cassette, the nurse is counting the number of doses of eachmedication and associating those doses with the patient. When thescanning is done, the quantity of medications in each cassette will beaccurately documented. The cassette is then loaded into the cart at 458and workflow returns to the inquiry 452 to determine if there are anyadditional cassettes for this nurse. If not, process flow continues with460 where the cart is locked. An inquiry is made at 462 to determine ifConnect-Rn is enabled. If not, the nurse proceeds to the cabinet asshown by 464. If Connect-Rn is enabled, a determination is made at 466if medications are in a dispensing cabinet. If yes, the nurse proceedsto the cabinet and either from inquiry 466 or step 464, the nurseunlocks the cart at 468. The nurse then performs the process 218 ofcollecting medications which has previously been described in connectionwith FIG. 6B. After the process 218 of FIG. 6B is completed an inquiryis made at 470 to determine if there are medications to load. If thenurse went directly to the cabinet without Connect-Rn being enabled, itis possible that there were no medications in the cabinet to bedispensed and thus the determination 470 is needed. If medications havebeen dispensed as a result of process 218, the nurse scans the cassetteat 472 and then loads the medication into the cassette at 474.Medication quantities dispensed as a result of process 218 are thusautomatically added to the cassette's medication counts. After all themedications have been loaded, or if no medications were in the cabinetas determined by inquiry 466, the cart is locked at 476 and the workflowfor collecting medications ends.

It should be noted that patient cassettes typically contain a day'sworth of medications for a patient while dispenses from a cabinet areusually the next due medications. Thus, the dispense from the cabinetmay need to be adjusted if the healthcare worker wishes to have a fullday's worth of medications for patient's on that healthcare worker'srounds.

The present invention provides additional functionality for nurses asset forth in the figures. The present invention also adds greater valueto the wireless infrastructure investment. By integrating thefunctionality set forth in FIG. 1 in a handheld device 10, mobile cart,or other portable device, an integrated suite of tools can be providedwhich allows the nurse to perform his or her duties in a seamless mannerregardless of the duty or location in which it is performed. Forexample, new prescriptions and new orders may be scanned and input to apharmacy system as soon as they are written by a physician. Nursing timeis saved in that nurses can either obtain all their medications in oneplace or be directed to where the medications needed for a particularpatient are located. With certainty in obtaining the medications at theindicated locations, it is less likely that nurses will “borrow”medications from other patient cassettes. A nurse can “pre-pick”patients and medications on the handheld device 10 so that time spent ata dispensing cabinet can be spent dispensing medications, rather thanpicking patients and medications. Additionally, the nurse can take thesame handheld device 10 into a storage area and select medical suppliesfor a patient. Thereafter, the same handheld device 10 can be taken to apatient's bedside for administration of the dispensed medications andsupplies.

1. A system, comprising: an automated medication dispensing device; acomputer located remotely of said dispensing device for communicatingwith said dispensing device and for sending a queue of dispensing ordersto said dispensing device; and an authentication device for confirmingwhen the user is located proximate to said dispensing device, saiddispensing device being responsive to said authentication device forperforming said queued dispensing orders.
 2. The system of claim 1wherein said computer is a wireless, handheld computer used foradministering dispensed medications.
 3. The system of claim 1 whereinsaid computer is located on a mobile cart.
 4. The system of claim 1wherein said automated medication dispensing device comprises a computercontrolled dispensing cabinet and wherein said queue of dispensingorders is organized per user and per patient.
 5. The system of claim 4wherein said dispensing cabinet accepts logon information input to thecomputer located remotely of said dispensing device.
 6. The system ofclaim 1 wherein said dispensing device is part of a dispensing system,said computer for communicating with said dispensing system to identifythe location of medications within said dispensing system.
 7. The systemof claim 6 additionally comprising a pharmacy, said computer forrequesting a medication from said pharmacy which is missing from saiddispensing system.
 8. The system of claim 1 additionally comprising asupply issuing system, said computer for communicating with said supplyissuing system to identify the location of supplies within said supplyissuing system.
 9. A system, comprising: a medication dispensing device;at least one database for maintaining an inventory of items locatedwithin said dispensing device; a computer located remotely of saiddispensing device for communicating with said database to create a listof medications to be dispensed; and a device for confirming when theuser is located proximate to said dispensing device, said list ofmedications being sent to said dispensing device in response to saidconfirmation.
 10. The system of claim 9 wherein said computer is locatedremotely of said database.
 11. The system of claim 10 wherein saidcomputer is a wireless, handheld computer used for administeringdispensed medications.
 12. The system of claim 10 wherein said computeris located on a mobile cart.
 13. The system of claim 9 wherein saidautomated medication dispensing device comprises a computer controlleddispensing cabinet and wherein said list of medications to be dispensedis organized per user and per patient.
 14. The system of claim 13wherein said dispensing cabinet accepts logon information input to thecomputer located remotely of said dispensing device.
 15. The system ofclaim 9 wherein said dispensing device is part of a dispensing system,said computer for communicating with said database to identify alocation for each of the medications on the list to be dispensed. 16.The system of claim 15 additionally comprising a pharmacy, said computerfor requesting a medication from said pharmacy which is missing fromsaid dispensing system.
 17. The system of claim 9 additionallycomprising a supply issuing system, said computer for communicating withsaid supply issuing system to identify the location of supplies withinsaid supply issuing system.
 18. The system of claim 9 additionallycomprising a data replicator for updating the database with an inventoryof medications within said medication dispensing device.
 19. A system,comprising: a medication dispensing system; and a computer locatedremotely of said dispensing system for communicating with saiddispensing system to identify a location within said medicationdispensing system where items to be dispensed are located.
 20. Thesystem of claim 19 wherein said computer is a wireless, handheldcomputer used for administering dispensed medications.
 21. The system ofclaim 19 wherein said computer is located on a mobile cart.
 22. Thesystem of claim 19 wherein said computer communicates with saidmedication dispensing system and sends a queue of dispensing orders to adevice within said dispensing system, said system further comprising anauthentication device for confirming when a user is located proximate tosaid dispensing device, said dispensing device being responsive to saidauthentication device for performing said queued dispensing orders. 23.The system of claim 22 wherein said queue of dispensing orders isorganized per user per patient.
 24. The system of claim 22 wherein saiddispensing device accepts logon information input to the computerlocated remotely of said dispensing system.
 25. The system of claim 19additionally comprising a pharmacy, said computer for requesting amedication from said pharmacy which is missing from said dispensingsystem.
 26. The system of claim 19 additionally comprising a supplyissuing system, said computer for communicating with said supply issuingsystem to identify the location of supplies within said supply issuingsystem.
 27. A system, comprising: a medication dispensing system; atleast one database for maintaining an inventory of items located withinsaid dispensing system; a computer located remotely of said dispensingsystem for communicating with said database to identify a locationwithin said medication dispensing system where items to be dispensed arelocated.
 28. The system of claim 27 wherein said computer is locatedremotely of said database.
 29. The system of claim 28 wherein saidcomputer is a wireless, handheld computer used for administeringdispensed medications.
 30. The system of claim 28 wherein said computeris located on a mobile cart.
 31. The system of claim 27 wherein saidcomputer communicates with said medication dispensing system and sends aqueue of dispensing orders to a device within said dispensing system,said system further comprising an authentication device for confirmingwhen a user is located proximate to said dispensing device, saiddispensing device being responsive to said authentication device forperforming said queued dispensing orders.
 32. The system of claim 31wherein said queue of dispensing orders is organized per user perpatient.
 33. The system of claim 31 wherein said dispensing systemaccepts logon information input to the computer located remotely of saiddispensing device.
 34. The system of claim 27 additionally comprising apharmacy, said computer for requesting a medication from said pharmacywhich is missing from said dispensing system.
 35. The system of claim 27additionally comprising a supply issuing system, said computer forcommunicating with said supply issuing system to identify the locationof supplies within said supply issuing system.
 36. The system of claim27 additionally comprising a data replicator for updating the databasewith an inventory of medications within said medication dispensingsystem.
 37. A method, comprising: inputting logon information into asystem via a remote computer; creating via said remote computer a listof medications to dispense; verifying that an authorized user is locatedproximate to a dispensing device; transmitting the list of medicationsto the dispensing device; and dispensing the medications on said list.38. The method of claim 37 additionally comprising administering thedispensed medications using the remote computer.
 39. The method of claim37 wherein said list is organized per user and per patient.
 40. Themethod of claim 37 wherein the dispensing device accepts the logoninformation input to the system as logon information for the dispensingdevice.
 41. The method of claim 37 additionally comprising identifyingthe location of the medications to be dispensed within a medicationdispensing system.
 42. The method of claim 41 additionally comprisingrequesting from a pharmacy a medication which is missing from thedispensing system.
 43. The method of claim 37 additionally comprisingissuing supplies using the remote computer.
 44. A method comprising:inputting logon information into a system via a remote computer;maintaining in a database an inventory of items located within adispensing device; communicating with the database via the remotecomputer to build a list of medications to be dispensed; verifying thatan authorized user is located proximate to the dispensing device;transmitting the list of medications to the dispensing device; anddispensing the medications on said list.
 45. The method of claim 44additionally comprising administering the dispensed medications usingthe remote computer.
 46. The method of claim 44 wherein said list isorganized per user and per patient.
 47. The method of claim 44 whereinthe dispensing device accepts the logon information input to the systemas logon information for the dispensing device.
 48. The method of claim44 additionally comprising identifying the location of the medicationsto be dispensed within a medication dispensing system.
 49. The method ofclaim 48 additionally comprising requesting from a pharmacy a medicationwhich is missing from the dispensing system.
 50. The method of claim 44additionally comprising issuing supplies using the remote computer. 51.The method of claim 44 additionally comprising updating the inventory ofitems located within the dispensing device.
 52. A method, comprising;inputting logon information into a system via a remote computer; andidentifying via the remote computer a location within a medicationdispensing system where items to be dispensed are located.
 53. Themethod of claim 52 additionally comprising: creating via the remotecomputer a list of medications to dispense; verifying that an authorizeduser is located proximate to a dispensing device; transmitting the listof medications to the dispensing device; and dispensing the medicationson the list.
 54. The method of claim 53 additionally comprisingadministering the dispensed medications using the remote computer. 55.The method of claim 53 wherein the list is organized per user and perpatient.
 56. The method of claim 53 wherein the dispensing deviceaccepts the logon information input to the system as logon informationfor the dispensing device.
 57. The method of claim 52 additionallycomprising requesting from a pharmacy a medication which is missing fromthe dispensing system.
 58. The method of claim 52 additionallycomprising issuing supplies using the remote computer.
 59. A method,comprising: inputting logon information into a system via a remotecomputer; maintaining in a database an inventory of items located withina dispensing system; and communicating with the database via the remotecomputer to identify a location within the medication dispensing systemwhere a medication to be dispensed is located.
 60. The method of claim59 additionally comprising: communicating via the remote computer withthe database to create a list of medications to dispense; verifying thatan authorized user is located proximate to a dispensing device;transmitting the list of medications to the dispensing device; anddispensing the medications on the list.
 61. The method of claim 60additionally comprising administering the dispensed medications usingthe remote computer.
 62. The method of claim 60 wherein the list isorganized per user and per patient.
 63. The method of claim 60 whereinthe dispensing device accepts the logon information input to the systemas logon information for the dispensing device.
 64. The method of claim59 additionally comprising requesting from a pharmacy a medication whichis missing from the dispensing system.
 65. The method of claim 59additionally comprising issuing supplies using the remote computer. 66.A method of preparing a mobile cart for medication administrationrounds, comprising: loading the cart with medications already dispensedfor a specific patient; dispensing additional medications for saidpatient; and loading said additional medications onto the cart.
 67. Themethod of claim 66 wherein said loading the cart with medicationsalready dispensed for a specific patient includes loading onto the carta patient specific cassette.
 68. The method of claim 67 wherein saidloading said additional medications onto the cart includes loading theadditional medications into the patient specific cassette.